Nursing Care Provider Ii: Exam 2

Front 1

Adult wall suction
Adult portable

Back 1

80/100-120 mm Hg (wall)
7-15 mm Hg (portable)

Front 2

Child wall suction
Child portable
Infant
Preterm infant:

Back 2

60- 100 mm Hg (wall)
5-8 mm Hg (portable)
3-5 (portable)
40- 60 mm Hg (wall)adult

Front 3

Catheter Size
adult vs Child

Back 3

For adult- 12 to 16 French
For children- 5 to 14 French depending on age.

Front 4

Shallow suctioning

Back 4

Catheter tip just go into the hub of the trach tube

Front 5

Pre-measured suctioning

Back 5

Measure it with the same size trach tube

Front 6

Deep suctioning

Back 6

Insert the catheter till resistance is met and withdraw 1cm (1/2 inch)

Front 7

Order of suction

Back 7

Suction trach, then nasal and oral cavity

Front 8

Paroxysms of coughing occurs:

Back 8

give oxygen, allow to rest between suction, consult physician for need for inhaled bronchodilator

Front 9

Return of bloody secretion:

Back 9

: check the suction pressure used, evaluate the suctioning frequency and report to doctor ASAP. BUT tinge of bloody secretion a day after tracheostomy tube insertion is a normal finding.

Front 10

No secretion:

Back 10

assess fluid status, signs of infection, need for chest physio, adequacy of humidification on oxygen delivery device.

Front 11

Catheter insertion:
Adult:
Older children:
Infants and young children:

Back 11

Adult: 16 cm (6.5 inches)
Older children: 8 to 12 cm (3 to 5 inches)
Infants and young children: 4 to 8 cm (1.5 to 3 inches)

Front 12

Frequency of changing suction catheter of a
open system
closed system

Back 12

open system: use sterile, single use catheter
closed system: unresolved issue

Front 13

Emergency Keep at bed side:

Back 13

Tube of equal or smaller size for emergency reinsertion
Ambu bag and obturator
Others (equipments needed for care)

Front 14

First tube is changed by
Tube should be changed q

Back 14

physician no sooner than 7 days after tracheostomy

monthly

Front 15

Clean inner cannula with

Back 15

hydrogen pero-oxide and sterile NS

Front 16

Tape (tie, twill) should be snugly tied allowing
in children:
adult:

Back 16

child: 1 little finger
adult: 1-2 fingers

Front 17

Home care parent teaching
length catheter used:

Back 17

length catheter used: 1 day

Front 18

Home care parent teaching

Back 18

Secure the tape properly
Loose clothing around the neck
No bib over the tracheostomy
Avoid soap & water getting in the tracheostomy tube. If enters, suction immediately

Keep talcum powder, small toys away
Avoid clothing and toys that shed a lot of fibers
Avoid long haired pets and birds
Avoid smoking & spraying things in front of the client with a tracheostomy
Do not recommend a child to play with dry sand. May play with wet sand under supervision
In BABIES, it is better to suction before feeding as secretion tend to increase during feeding. Do not suction immediately after feeding , may vomit

Front 19

Tracheostomy Care: Deflation steps

Back 19

aspiration
Patient should cough up secretions prior to deflation to avoid aspiration
Suction mouth and tube before deflation
Remain with patient when cuff is initially deflated unless patient can protect against aspiration and breathe without respiratory distress
Deflate tube during exhalation

Front 20

Early signs:
HYPOXIA

Back 20

Restlessness, mood changes, mental changes
Irritability, Anxiety
Confusion/ disorientation/ altered behavior
Decreased ability to concentrate
Altered level of consciousness, Syncope (fainting)
Altered vitals (tachycardia, tachypnea, high BP) BP is usually high unless in case of shock

Front 21

Late signs:
HYPOXIA

Back 21

Cyanosis
Cardiac dysrhythmias (irregular and/or premature)
Dyspnea

Front 22

PEAK EXPIRATORY FLOW RATE (PEFR) 5 steps

Back 22

Step 1: Before each use, make sure the sliding marker is at zero.
Step 2: Stand up straight, take a deep breath, put the mouthpiece of the peak flow meter into your mouth, close your lips tightly around the mouthpiece, and blow out as hard and as quickly as possible.
Step 3: Note the number on a note pad. Step 4: Repeat the entire routine three times. Step 5: Record the highest of the three ratings. Do not calculate an average. Note: Measure your peak flow rate close to the same time each day. You may want to measure your peak flow rate before or after using medicine.

Front 23

NASAL CANNULA/ PRONG
Advantages/dis

Back 23

Advantages: Used in adult & children
Easy to apply
Disposable and inexpensive
Well tolerated, easy to talk, eat

Front 24

NASAL CANNULA/ PRONG
Disadvantages

Back 24

Disadvantages: Unstable, easily dislodged
High flow uncomfortable
Drying of mucosa/ bleeding
Difficult controlling Oxygen concentration in nose breather

Front 25

Simple Face Mask:

Back 25

Simple Face Mask:
Requires high O2 flow to prevent re-breathing of carbon dioxide
Almost 75% of the inspired volume is room air drawn through the holes in the mask
40- 60% O2 is delivered (5Lto 8L/minute)

Front 26

Non-rebreathing Mask:

Back 26

Used in older children and adult
Has one way valve on the mask that prevents room air and the clients exhaled air from entering the bag so only O2 in the bag is inspired
Bag must remain partially inflated
Delivers highest concentration of O2 (95-100%)

Front 27

Venturi Mask

Back 27

4L- 12L/minute (24%- 60%)
Has different sized adaptors to deliver precise amount of oxygen
Can administer higher conc. of oxygen
Mask is used for clients with COPD when precise O2 rates are necessary
Humidifiers are not usually used with this system.
Nursing responsibility: Assess placement & fit of mask, and skin under mask

Front 28

o2 formula for Calculation

Back 28

FiO2 = Liter of flow X 4 + 20
1 L = 24 and add 4 to each extra liter

1L = 24% + 4 for every L

Front 29

pneumothorax site

Back 29

higher anteriorly around 2nd or 3rd inter-costal space on the mid-clavicular line or mid-axillary line

Front 30

Draining excess fluid site

Back 30

lower lower inter-costal space (6th -8th)

Front 31

CHEST DRAINAGE SYSTEM: PLEUR-EVAC chambers 1,2 ,3 (closest to Pt.)

Back 31

1st compartment (next to client): drainage chamber
2nd compartment (middle chamber): water seal
2 cm of sterile water or NS
3rd compartment: suction control chamber
Two types: water & dry
The amount of suction is controlled by how much sterile water/NS (15-20cm in adult) is added in the suction compartment
May use suction machine

Front 32

Heimlich valve

Back 32

Collapsible rubber tube used to evacuate air from the pleural space

The valve opens whenever the pressure in the pleural cavity is higher than atmospheric pressure and closes when reverse occurs

Used for emergency transport or special home care situation

Front 33

Immediately after attach drain system and what dressing?

Back 33

Occlusive dressing is applied. Petrolatum gauze may be placed around the insertion site

Front 34

Palpate insertion site after insertion

Back 34

around the insertion site subcutaneous emphysema.

Front 35

Positioning of client with Chest system

Back 35

Position the drainage system in upright position, below the level of chest
Coil and secure excess tube next to client

Front 36

emergency equipment in pt. room with chest tube

Back 36

bottle of sterile water, 4x4 vaseline gauze, tape and non-toothed padded

Front 37

position for pneumothorax

Back 37

Semi-Fowler’s

Front 38

position for hemothorax

Back 38

High Fowler’s

Front 39

Do not remove pleural fluid>

Back 39

(1500) at one time

Front 40

attached to suction chest system should...

Back 40

continuous/ gentle bubbling in suction chamber indicates system is functioning well (tidalling well)

When NOT attached to suction, water level will act as suction. If suction pressure needs to be increased, water is added per doctor’s order.

Front 41

Dry suction system

Back 41

Rise & fall in the fluid level during inspiration & expiration or intermittent bubbling is normal
If no fluctuation/ no air bubbles, lungs may have re-expanded

Front 42

chest tube gets D/C from the drainage unit...

Back 42

instruct the client to exhale as much as possible & cough to remove air from the pleural space. Then clean the tube & reconnect it quickly

Front 43

If the drainage unit is broken

Back 43

the end of the chest tube should be submerged in a container of sterile water (2 cm level) ASAP. DO not clamp

Front 44

If the chest tube is pulled out

Back 44

apply occlusive dressing (priority) & call doctor immediately

Front 45

Maintain patency of the chest tube

2 to do

Back 45

Keep tubing free of kinks

Avoid stripping/milking tube (increases intra-thoracic pressure). If necessary, may squeeze and release tube gently.

Front 46

Criteria for Removal of chest tube
lungs..
fluid drain..

Back 46

Priority assessment of breath sound (1st step in nursing process)
Lung is re-expanded, confirmed by x-ray
Fluid drainage is stopped or decreased (< 50 cc for 24 hours)
No fluctuation in water seal for a day
client satble normal baseline breathing

Front 47

REMOVAL CHEST TUBE by physician

Back 47

Pre-medicate for pain
Explanation of procedure
Ask to exhale & bear down (valsalva maneuver) while pulling out the tube
Apply occlusive dressing
Observe for respiratory distress for 1-2 hours after removal or longer if necessary.

Front 48

S.T.O.P.

EASY WAYS TO ASSESS CHEST TUBE DRAINAGE SYSTEM

Back 48

Site: dressing, bleeding &
subcutaneous emphysema
Tube: taping & looping
Output: checking, marking &
documenting
Patient: Patient, patient, patient